The Six-Legged Stool: Building Strong CFO Leadership in FQHCs
A Framework for Recruiting and Developing Community Health Center Finance Leaders
When it comes to leadership in Federally Qualified Health Centers (FQHCs), the CFO role is one of the most complex and critical. At Community Link Consulting, we've been helping FQHCs recruit, support, and develop CFOs for more than 20 years. Along the way, we've discovered something important: the qualities that make a successful CFO can't be boiled down to one factor, or even three.
Originally, we thought of the role as a "three-legged stool." But as FQHCs have grown more complex, that model no longer held up. Today, we use the six-legged stool framework as a guide when evaluating CFO candidates. This framework provides a clear way to illustrate the balance required for success in FQHC financial leadership.
The Six Legs of a Strong FQHC CFO
1. Communication
The CFO's role goes far beyond numbers. They must be able to communicate clearly and effectively with their finance team, with the CEO, with the board and finance committee, and across departments. Translating complex financial realities into language that drives understanding and alignment is a non-negotiable skill.
2. Focus
FQHCs operate in an environment of competing priorities, shifting regulations, and constant deadlines. The CFO needs the discipline to focus on what matters most, ensuring critical tasks don't get lost in the noise. Without this, even the best strategies or technical skills fall flat.
3. Strategy & Analysis
It's not enough to report results. An effective CFO rises above the day-to-day to provide forward-looking insight: Where is the organization now? Where is it going? How can financial strategy support long-term sustainability? This ability to analyze trends, frame options, and guide decision-making is what makes a CFO a true partner to the CEO and the board.
4. Accounting Knowledge & Theory
While vision is essential, a CFO in an FQHC must also be able to dig into the details. From supporting staff with technical accounting questions to spotting inconsistencies in reports, a strong foundation in accounting theory ensures credibility and confidence in the numbers.
5. Hard Work
The reality is that FQHC CFOs don't clock out at 5:00 p.m. In addition to the "standard" CFO responsibilities, they face extensive compliance requirements and must oversee the revenue cycle, the largest and most complex financial system in the organization. Success in this role requires grit, stamina, and a willingness to lean in when the work gets heavy.
6. Healthcare & FQHC Experience
Industry knowledge helps. Familiarity with acronyms, deadlines, and systems makes the learning curve shorter and decision-making faster. But while this experience is valuable, it is not the most important factor. It's just one leg of the stool, not the whole seat.
Rethinking What Matters Most
Many boards, recruiters, and CEOs place disproportionate weight on FQHC experience when searching for a CFO. While it certainly has value, our experience shows that it's the combination of all six legs that creates stability. Overemphasizing one leg—especially at the expense of others—leads to imbalance.
When we use the six-legged stool as our guide, we're reminded that the best CFOs in Community Health Centers aren't defined by one trait or one credential. They're defined by balance, adaptability, and the ability to support the mission from every angle.
At Community Link Consulting, we've built this framework into our recruiting and advisory process. Our goal is to help FQHCs identify not just good CFOs—but great ones who can strengthen the organization for the long term.
Ready to strengthen your CFO leadership or find the right financial leader for your FQHC? Contact Community Link Consulting at 509-226-1393 or info@communitylinkconsulting.com for expert guidance in FQHC recruitment and financial leadership development.
About the Author
Karen Creveling-Hughes, CPA, CEO
Community Link Consulting
Phone: 509-226-1393
Email: info@communitylinkconsulting.com
Karen brings over 25 years of experience helping Federally Qualified Health Centers build strong leadership teams and navigate complex financial challenges. As CEO of Community Link Consulting, she has guided the recruitment and development of CFOs for community health centers nationwide.
